burden of illness. overview patient-reported burden of neuropathic pain is significant 3...

BURDEN OF ILLNESS

Overview

Patient-Reported Burden of Neuropathic Pain Is Significant

3Cruz-Almeida Y et al. J Rehab Res Dev 2005; 42(5):585-94; Gilron I et al. CMAJ 2006; 175(3):265-75; Jensen MP et al. Neurology 2007; 68(15):1178-82; Khenioui H et al. Ann Readapt Med Phys 2006; 49(3):125-37; Meyer-Rosberg K et al. Eur J Pain 2001; 5(4):379-89.

Both the intensity of the pain and the duration of the condition exacerbate the patient’s burden

Physical Burden

Chronic Neuropathic Pain Has a Significant Impact on Daily Functioning

BPI = Brief Pain Inventory, which scores extent pain interferes with activities in last 24 hours from 0 (does not interfere) to 10 (completely interferes)Adapted from: Smith BH et al. Clin J Pain 2007; 23(2):143-9.

Pain

inte

rfer

ence

*

**

*

*

*

*

*p <0.001

*

Chronic Neuropathic Pain Significantly Impairs Quality of Life

0

25

50

75

100

Physicalfunctioning

Physicalrole

Bodily pain Generalhealth

Vitality Socialfunctioning

Emotionalrole

Mentalhealth

Me

an

SF

-36

sc

ore

No chronic pain (n = 1537) Chronic non-neuropathic pain (n = 1179)Chronic neuropathic pain (n = 241)

SF-36 = Short Form 36Adapted from: Smith BH et al. Clin J Pain 2007; 23(2):143-9.

Meyer-Rosberg K et al. Eur J Pain 2001; 5(4):379-89; Vinik AI et al. Diabetes Care 2003; 26(5):1553-79.

Patients with Peripheral Neuropathic Pain Experience Significant Comorbid Symptoms

Pain

inte

rfer

ence

Workers with Painful Diabetic Peripheral Neuropathy Have Lower Quality of Life Scores

Quality of life scoresfrom SF-12v2

Workers with painful diabetic peripheral

neuropathy

Workers without painful diabetic peripheral

neuropathy

Physical component summary 39.0 50.5

Mental component summary 43.7 47.3

SF-12v2 = Short-Form 12 version 2National Health and Wellness Survey (NHWS) 2008.

Postherpetic Neuralgia Affects Multiple Quality of Life Domains

Drolet M et al. CMAJ 2010; 182(16):1731-6.

Percentages of Participants with Postherpetic Neuralgia (n = 63) Who Reported Problems in the EuroQol EQ-5D

% o

f pati

ents

repo

rting

pro

blem

s

At 90 days after rash onset

Self-care Usualactivities

Pain/discomfort

Anxiety/depression

100

90

80

70

60

50

40

30

20

10

0

At 180 days after rash onset

Mobility

Economic Burden

The Economic Burden of Neuropathic Pain Is due to Reduced Productivity and Increased Health Care Costs

Berger A et al. J Pain 2004; 5(3):143-9; Lachaine J et al. Pain Res Manage 2007; 12(1):31-7; Meyer-Rosberg K et al. Eur J Pain 2001; 5(4):379-89.

Reduced Productivity Increased Health Care Costs

Plus: indirect costs (lost productivity, wages, etc.)

Neuropathic Pain Reduces Employment

Direct impact of illness on employment

52%

Meyer-Rosberg K et al. Eur J Pain 2001; 5(4):379-89.

n = 126

Patients with Neuropathic Pain Experience Reduced Productivity at Work

80% of working patients had reduced work productivity because of their neuropathic pain.

n = 109 working

Pfizer Inc. Data on file, European Survey in Painful Neuropathic Disorders.

Reduced Productivity at Work in Past 4 Weeks for Patients with Neuropathic Pain

Workers with Painful Diabetic Peripheral Neuropathy Have Reduced Productivity

Source: National Health and Wellness Survey (NHWS) 2008.

12.3

34.8

40.5 42.0

4.6

16.419.0 19.4

0%

10%

20%

30%

40%

50%

Absenteeism Presenteeism Overall work impairment Activity impairment

Perc

ent

With painful diabetic peripheral neuropathy

Without painful diabetic peripheral neuropathy

Workers

Patients with Neuropathic Pain Have Higher Healthcare Utilization than Those without Neuropathic Pain

Patients with painful neuropathic disorder

(mean ± SD)

Patients without painful neuropathic

disorder (mean ± SD)

ANOVA

Visits to GPs 6.7 ± 13.5 3.4 ± 8.1 p <0.001

Visits to specialists 8.0 ± 14.0 3.0 ± 7.7 p <0.001

GP procedures 5.4 ± 8.0 2.2 ± 3.8 p <0.001

Specialist procedures 10.3 ± 14.8 3.6 ± 7.6 p <0.001

Days of hospitalization 2.9 ± 9.4 1.1 ± 5.1 p <0.001

GP = general practitioner; SD = standard deviationLachaine J et al. Pain Res Manag 2007; 12(1):31-7.

Workers with Painful Diabetic Peripheral Neuropathy Have Higher Healthcare Utilization

Resource use in thepast 6 months

Workers with painful diabetic peripheral

neuropathy (%)

Workers without painful diabetic peripheral

neuropathy (%)

>1 doctor visit 94.6 72.5

>1 non-traditional healthcare visit 35.3 21.9

>1 ER visit 24.6 11.7

>1 hospitalization 18.6 6.0

Number of prescription medicines 11.0 1.9

ER = emergency roomSource: National Health and Wellness Survey (NHWS) 2008.

Increasing Pain Severity Leads to Increasing Health Care Utilization in Patients with Diabetic Peripheral Neuropathy

m-BPI-DPN = modified Brief Pain Inventory for DPNZelman D et al. Pain 2005 115(1-2):29-36.

n = 255

2.3

3.4

5.5

Adults Aged ≥20 Years with a Diagnosis of Shingles Have More

Medical Visits

33

157

107

1154

0 200 400 600 800 1000 1200 1400

Inpatient hospitalization

Emergency room

Outpatient hospital

Physician office

Number of visits (K)Source: 2002–2006: National Ambulatory Medical Care Survey (NAMCS), National Hospital Ambulatory Medical Care Survey (NHAMCS) and National Hospital Discharge Survey (NHDS)Pfizer Medical Division. The Burden of Pain Among Adults in the United States. Pfizer Inc.; New York, NY: 2008.

Comorbidities

Comorbid Chronic Medical Conditions* Among Patients with Painful Neuropathic Disorders

*Based on health care claimsCHD = coronary heart disease; CHF = congestive heart failure; COPD = chronic obstructive pulmonary diseaseBerger et al. J Pain 2004; 5(3):143-9.

Meyer-Rosberg K et al. Eur J Pain 2001; 5(4):379-89; Vinik AI et al. Diabetes Care 2003; 26(5):1553-79.

Patients with Peripheral Neuropathic Pain Experience Significant Comorbid Symptoms

Pain

inte

rfer

ence

Neuropathic Pain Is Associated with Sleep Disturbance, Anxiety and Depression

Pain

Sleepdisturbances

Anxiety anddepression

Functional impairment

Nicholson B, Verma S. Pain Med 2004; 5(Suppl 1):S9-27.Nicholson B, Verma S. Pain Med 2004; 5(Suppl 1):S9-27.

Many Patients with Diabetic Neuropathy Have Sleep and Mental Health Comorbidities

MDD = major depressive disorderDavis JA et al. J Pain Res 2011; 4:331-45.

n = 37,133

Many Patients with Postherpetic Neuralgia Have Sleep and Mental Health Comorbidities

n = 3551

MDD = major depressive disorderDavis JA et al. J Pain Res 2011; 4:331-45.

Patients with Postherpetic Neuralgia Have Significant Pain-Related Sleep, Mood and Activity Impairment

Magnitude of Impairment on Modified Brief Pain Inventory (n = 385)

Moderate: 4–6; Severe: 7–10Oster G et al. J Pain 2005; 6(6):356-63.

DN4 = Douleur neuropathique en 4 questionsAttal N et al. Pain 2011; 152(12):2836-43.

Patients with Chronic Neuropathic Pain Have More Anxiety and Depression than Those with Chronic Pain without

Neuropathic Pain

Anxiety and depression scores were correlated with the DN4 score

Patients with Chronic Neuropathic Pain Have More Sleep Disturbances than Those with Chronic Pain without

Neuropathic Pain

Attal N et al. Pain 2011; 152(12):2836-43.

Summary

Burden of Illness: Summary

• Neuropathic pain is associated with:– Substantial functional impairment across

multiple domains– Reduced quality of life– Decreased productivity– Increased healthcare utilization– Sleep and mental health comorbidities